The Psychological Effects of Abortion for Adolescents

Editor's Note: The following studies examine the psychological aftermath of abortion among adolescent and adult women. Well-designed research supports the proposition that the psychological outcomes of abortion for adolescents differ little from those for adults. Studies suggesting alternative findings generally have serious methodological limitations.

Citation: Pope, L. M., Adler, N. E., & Schann, J. M. (2001). Postabortion psychological adjustment: Are minors at increased risk? Journal of Adolescent Health, 29, 2-11.

Introduction: Some state laws in the U.S. mandate parental consent or notification before an adolescent can obtain a legal abortion. An assumption supporting such legislation is that adolescents are more likely to experience negative psychological outcomes. Few prior studies have investigated the psychological effects of abortion on adolescents. This study examines the psychological outcomes of abortion, the predictors of negative outcomes, and the relative risk of these outcomes for adolescents under age 18 as compared to women aged 18-21.

Methods: A multiethnic sample of women aged 14-21 seeking first trimester abortions was recruited from 4 clinics in San Francisco, California. Each woman participated in 2 face-to-face interviews: 1-2 days preabortion and 4 weeks post abortion. Of the 96 participants recruited, 66% were re-interviewed at 4 weeks. The preabortion questionnaire assessed demographic characteristics, depression (Beck Depression Inventory), emotions surrounding the abortion, feelings about pregnancy and decision making difficulty. The postabortion questionnaire included measures of anxiety (Speilberger State-Trait Anxiety Inventory), self-esteem (Rosenberg Self-Esteem Scale), stress (Impact of Events Scale) and positive states of mind. Chi square, t-test and correlation were used to analyze data.

Results: The only difference between the two age groups was that those aged 14-17 reported less comfort with their decision. The total sample showed significant decreases in depression and internally-based negative emotions (such as regret) and increases in positive emotions at 4 week follow-up. The psychological characteristics of this sample of adolescents 4 weeks postabortion appeared similar to those of comparison samples of adolescents. Risk factors for poor postabortion functioning were preabortion adjustment and the amount of partner pressure to have an abortion. The authors conclude that the study does not support the conclusion that adolescents are at increased risk of negative psychological consequences of abortion.

Evaluation: This study represents a needed contribution to the limited literature on the mental health effects of abortion for adolescent women. However, I would like to have seen a longer follow-up period and comparison groups of similarly aged adolescents not seeking abortion. This paper has strong policy and service delivery implications. According to these findings, legislation that limits adolescents' access to abortion is unwarranted. Practical applications include educating adolescent women who seek abortion about the risk of not freely choosing this alternative; providing back-up mental health services for women with preabortion adjustment difficulties; and educating abortion counselors/providers to better screen for such risk factors

Citation: Franz, W., & Reardon, D. (1992). Differential impact of abortion on adolescents and adults. Adolescence, 105, 27,161-172.

Introduction: Few studies have systematically compared psychological outcomes for adolescents and adult women. This study's objectives were to examine components of postabortion distress and compare negative long-term psychological reactions to abortion of adolescents and adults.

Methods: A survey was completed by 252 women aged 16 to 64 (modal age, 27) in 42 states, recruited through support groups for women who have had negative reactions to abortion. Survey questions using Likert scales measured satisfaction with the abortion decision, satisfaction with services, perceived severity of psychological distress related to the abortion, the degree to which the participants felt rushed or pressured to have the abortion and other related abortion experiences. Demographic characteristics also were assessed. Women who had an abortion at age 19 or younger and women aged 20 and older at time of abortion were compared using t-test and chi-square statistics.

Results: Those who had experienced an abortion as adolescents were less satisfied with the abortion services received and more likely to believe that they wanted to give birth but circumstances forced them to have an abortion. This group also reported greater abortion-related psychological distress, greater feelings of being misinformed at the time about the abortion experience and abortions later in gestation. Age at abortion was positively associated with current satisfaction with the abortion decision. Feeling dissatisfied, pressured and uninformed at time of abortion were associated with reports of a "worsened self-image," postabortion and a more severe negative emotional reaction.

Evaluation: It frequently is assumed that adolescents suffer more severe psychological consequences of abortion than adult women presumably because of their more poorly developed decision making ability and greater egocentrism. Although this paper appears to support such a view, its serious methodological flaws, sloppy reporting of findings, and inaccurate conclusions negate much of its value. For instance:

• The authors conclude, "adolescents were significantly more likely to be dissatisfied with the choice of abortion than were older subjects." Yet, the retrospective design did not sample adolescents but rather explored current perceptions of reactions to abortion and past abortion experiences among women self-identified as having postabortion problems.
• The researchers chose to separately examine 24 individual items of unknown origin and validity rather than using well-validated scales.
• The research did not adjust for the large number of significance tests run.
• There are many feasible explanations other than developmental level for why women in this particular sample who had abortions while still in their teens reported more severe postabortion psychological distress than women who were older at time of abortion. Most likely the groups differed in preabortion psychological functioning and ambivalence about the abortion, factors shown to be predictive of postabortion psychological functioning.

It is difficult to draw any practical recommendations from this study. However, the authors' call for better counseling certainly is valid. Pregnant adolescents and adults as well, need to be fully informed about their options and have adequate time to process their decisions. Equally important are pregnancy prevention programs for teenagers and education for adolescents and their parents about all options open to the pregnant adolescent and their potential effects.

Citation: Zabin, L.S., Hirsch, M.B., & Emerson, M.P. (1989). When urban adolescents choose abortion: Effects on education, psychological status and subsequent pregnancy, Family Planning Perspectives, 26 (6), 248-255.

Introduction: Research up until the time of this study had examined adolescent childbearing, but paid little attention to adolescents who choose abortion. The current study attempted to address methodological problems of past research, such as the lack of appropriate controls and attention to confounds. The study examined educational, economic, psychological, and reproductive behavior differences between adolescents who choose abortion and those who choose to carry their pregnancies to term.

Methods: Data were collected in 1985 and 1986 on 360 low-income African-American women 17 years old or younger who presented for pregnancy tests in a medical setting. Baseline data were collected before each woman knew the result of her pregnancy test. Women were then placed into one of three groups: those whose tests were positive and intended to have an abortion, those who intended to carry the pregnancy to term, and those whose tests came back negative. Participants were followed-up at six-month intervals for two years. Information on household structure, education, jobs and economic well-being, health, growth, sexual and contraceptive behavior, conception and fertility, self-esteem, locus of control, and anxiety symptoms was gathered. Emphasis in data analysis was on change in characteristics from baseline to follow-up.

Results: At baseline, there were few differences between the three groups. After two years, women in the abortion group were more likely to have graduated from high school or stayed in school at the appropriate grade level, and more likely to be better off economically than women in either of the two other groups. Levels of anxiety and other psychological outcomes were not significantly different between the three groups at follow-up. Additionally, women who had had abortions were less likely to experience a subsequent pregnancy during the two-year period.

Evaluation: This study provided an important addition to this literature in that it included two different control groups and regular follow-up measures over a significant period of time. Another strength is that it utilized baseline measures to assess not only initial differences between these groups-before even having a pregnancy confirmed-but also change over time. A definite weakness of the study is the evaluation of psychological symptoms, which only included measures of anxiety, self-esteem, and locus of control. Depression would have been an important variable to consider here as well. Substance use, often related to psychological distress, was also not included. Overall, this study did provide some useful information about a population that is at high-risk for unintended pregnancy.